Maternal Mortality is considered one measure of the quality of a country's healthcare. Prior to 2003, only 18 states in the US had a pregnancy question on their death certificate.
In 2003, the following "pregnancy question" was added to the standard US death certificate:
If female: (check appropriate box)
Not pregnant within the past year
Pregnant at the time of death
Not Pregnant, but pregnant within 42 days of death
Not pregnant, but pregnant 43 days to 1 year before death
Unknown if pregnant within the past year
Not all states adopted the 2003 revised death certificate. There has been no uniform reporting of maternal mortality. There has been no officially reported US maternal mortality rate since 2007.* As of 2013, Colorado and West Virginia didn't have a pregnancy question on their death certificates.
The object of the current study by MacDorman et al was 1) to develop and test methods for trend analysis of maternal mortality in the US from 2000-2014 and 2) to provide an overview of the observed trends. Using regression analysis, they concluded that the maternal mortality in the US had increased from 18.8 maternal deaths per 100,000 live births in 2000 to 23.8 maternal deaths per 100,00 live births in 2014. They estimated that 20.1% of the observed increase was due to a real increase in maternal mortality and that 79.9% was due to improved ascertainment.
The authors concluded that accurate measurement of maternal mortality is an essential first step in prevention efforts as it can identify at risk populations and measure the progress of prevention programs.
MacDorman M et al. Recent Increases in the U.S. Maternal Mortality Rate: Disentangling Trends From Measurement Issues. Obstetrics & Gynecology. 2016 September; Vol. 128(3): 447-455. doi:10.1097/ACOG.0000000000001556.